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Vol. 43 



Friday, 24 January 1964 



No. 2 



TABLE OF CONTENTS 
IMPORTANT - News Letter Renewal Notice Required. ... 3 
MEDICAL ABSTRACTS PREVENTIVE MEDICINE 



Fainting 5 

Filariasis of Testis 12 

FROM THE NOTE BOOK 

The President's Message 14 

Surgeons General of the Past. . • 14 
American Board Certifications . 16 

MISCELLANY 

Space and Astronautics 

Orientation Course 17 

Military Surgeons Meeting - 

Highlights and Awards 18 

Navy Medical Officers 

Aid in Iran Civic Action 19 

Soaps Versus Detergents - 

Warning to Doctors 21 

Training for Research in 

Psychiatric Nursing 21 

DENTAL SECTION 

Variations of the Typical 

Amalgam Preparation 22 

Professional Notes 25 



Ready*- Sdt - Snow 27 

Snow Tires Versus Chains 28 

Disease Vector Control 

Courses at Alaineda 28 

Emerging Animal Diseases 29 

Salmonella derby Gastroenteritis 

from Eggs . . 32 

Sylvatic Plague - ^.Colorado 33 

Know Your "Wlorld . , . 34 

Salmonella Resistance to 

Chloramphenicol 36 

Malathion Dust for Control of 

Body Lice .- • • • 37 

Tularemia - Spotted Fever - 

Murine Typhus 37 

Rickettsia Isolated from Wild 

Animals in Montana 38 

RESERVE SECTION 

Research Reserve Nuclear Sciences 

Seminar in Health Physics at 

Brookhaven National 

Laboratory 3 9 

American Specialty Board 

Certifications - 

MC USNR 39 



United States Navy 
MEDICAL NEWS LETTER 



Vol. 43 Friday, 24 January 1964 No. 2 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 
Rear Admiral A. S. Chrisman MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 

Contributing Editors 

Aviation Medicine • Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E, Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain K. W. Schenck MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



Policy 

The U. S. Navy Medical News Letter is basically an official Medical Depart- 
ment publication inviting the attention of officers of the Medical Department 
of the Regular Navy and Naval Reserve to timely up-to-date items of official 
and professional interest relative to medicine, dentistry, and allied sciences. 
The amount of information used is only that necessary to inform adequately 
officers of the Medical Department of the existence and source of such infor- 
mation. The items used are neither intended to be, nor are they, susceptible 
to use by any officer as a substitute for any item or article in its original 
form. All readers of the News Letter are urged to obtain the original of those 
Items of particular Interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter to; Commanding Officer, 
U.S. Naval Medical School, National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new addresses. 



The issuance of this publication approved by the Secretary of the Navy on 
28 June 1961. 



Medical News Letter, Vol. 43, No. 2 3 

I-M-P-O-R-T-A-N-T N-0-T-I-C~E 

U.S. Navy Medical News Letter Renewal Request Is Required 

Existing regulations require that all Bureau and office mailing lists be checked 
and circularized once each year in order to eliminate erroneous and duplicate 
nnailings. 

It is, therefore, requested that EACH RECIPIENT of the U. S. Navy 
Medical News Letter (Except U. S. Navy and Naval Reserve personnel on 
ACTIVE DUTY and U. S. Navy Ships and Stations) fill in and forward imme- 
diately the form appearing below if continuation on the distribution list is 
desired. However, all recipients, Regular and Reserve, are responsible for 
forwarding changes of address as they occur. 

Failure to reply to the address given below by 15 February 1964 will 
automatically cause your name to be removed from the files. If you are in an 
Armed Service other than Navy, please state whether Regular, Reserve, or 
Retired. 

Also, PLEASE PRINT LEGIBLY. If names and addresses cannot be 
deciphered, it is impossible to maintain correct listings. 

— Editor 



(Detach here) 

Commanding Officer, U. S, Naval Medical School 

National Naval Medical Center (date) 

Bethesda, Md. , 20014 

(Attn: Addressograph Office) 

I wish to continue to receive the U. S. Navy Medical News Letter. 

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Medical News Letter, Vol. 43, No. 2 



FAINTING 

Juergen E. Thomas MD and E. Douglas Rooke MD, Section of Neurology, 
Mayo Clinic, Rochester, Minn. Proceedings of the Staff Meetings of The 
Mayo Clinic 38(19), September 11, 1963, 

A brief disturbance in normal consciousness is one of the commoner casual 
ailments. When it is an isolated occurrence with an adequate explanation, 
the physician is seldom consulted. Most people are familiar with "fainting" — 
by which they mean any temporary disturbance in consciousness. 

However, if the difficulty recurs it may become a matter for concern, 
and an evaluation of the significance of such brief spells is a frequent prob- 
lem in almost any field of medical practice. 

The majority of these disturbances are syncopal in nature but, even 
so, they are not all innocuous. It may be important to weigh such episodes 
as evidence of underlying disease and to distinguish — often on the basis of the 
history alone — between syncope, vertigo, various types of convulsive disorder, 
and other comparable conditions. Because of the prevalence of this problem, 
the authors review it as it presents itself to the neurologist. In this discussion, 
they consider the various possible mechanisms involved in the production of 
syncope, review some of the diseases that may be related to these episodes, 
and finally discuss the features that distinguish syncope from other types of 
episodic disturbance in consciousness. 

The term "syncope" is used in this discussion to describe a clinical 
condition in which there is a rapid, even an abrupt, disturbance in conscious- 
ness. It is usually associated with pallor and perspiration, and the basic 
mechanism is an insufficient supply of blood to the vital centers in the brain. 
Several types of syncope are described among which the following are dis- 
cussed in detail: vasodepressor syncope, postural syncope, primary and 
reflex cardiac syncope, cerebrovascular syncope, pressor-postpressor syn- 
cope, and micturition syncope. 

Vasopressor or Vasovagal Syncope 

This is the classic benign faint. Among its predisposing factors are unaccus- 
tomed physical and mental exhaustion, chronic debility, a hot stuffy environ- 
ment, anxiety, and head trauma. The immediate precipitating events vary 
widely and include psychologic shocks, painful stimuli, loss of blood, and 
prolonged motionless standing. Vasodepressor syncope can occur at any age, 
but young persons are particularly susceptible. 

The clinical picture is remarkably uniform regardless of the cause. 
The patient is almost always in the upright position at the onset of the attack. 
He first notices a feeling of weakness and apprehension. This is soon followed 
by nausea, pallor, cold perspiration, and epigastric discomfort. Within a 
miatter of seconds or minutes, lightheadedness and blurring of vision set in 
and, unless protective measures are taken, the patient slumps to the floor 



6 Medical News Letter, Vol. 43, No. 2 

unconscious. In the recumbent position, consciousness quickly returns, but 
such symptoms as weakness, nausea, and perspiration may linger for some 
time. 

If one examines a person undergoing vasodepressor syncope under 
laboratory conditions, an initial rise in heart rate and blood pressure can be 
noted. Soon, however, blood pressure and heart rate fall precipitously and 
unconsciousness sets in. At this time, respiration is shallow, the pulse is 
weak, the face ghastly pale, the skin cold and sweaty, and the pupils respond 
poorly or not at all to light. Occasionally, urinary incontinence and minor 
convulsive twitching nciay be observed. 

Physiologic studies (1, 2) suggest that in the initial phase of the syn- 
copal syndrome there is insufficient return of blood to the heart, resulting in 
decreased cardiac filling. This, in turn, has been thought to effect reflex 
excitation of vasomotor brain- stem centers producing bradycardia, profuse 
perspiration, and active vasodilatation in the muscles. The decrease in total 
vascular resistance causes a drop in blood pressure which, in turn, leads to 
cerebral ischemia and syncope. 

Orthostatic Syncope 

In certain individuals, assumption of the erect position can precipitate a 
profound fall in blood pressure. Normally, when man assumes the upright 
position, intricate compensatory mechanisms swing into action and these 
serve to counteract gravitational forces upon the blood. If these mechanisms 
are intact but sluggish, symptoms such as dizziness, blurring of vision, and 
fainting may occur in response to postural changes. The writers call this 
situation poor postural adjustment. Although the simiple postural faint is 
probably nothing but a variant of the previously discussed vasodepressor syn- 
cope, it is convenient to group it separately because of its characteristic pre- 
cipitating factor. 

Divorced from the poor postural adjustment is the classic orthostatic 
syndrome (orthostatic hypotension), a truly distinctive entity, occurring in 
patients in whom the compensatory cardiovascular mechanisms have been 
suspended by a disease of the autonomic nervous system (3). In this condition, 
regulation of blood pressure is often severely and persistently disturbed and 
other autonomic dysfunction such as impairment of sweating, impotence, and 
disturbance of the bowel and bladder is manifest. True orthostatic hypoten- 
sion can be classified as secondary and primary or idiopathic. In the second- 
ary group belong especially endocrinologic -metabolic disorders and diseases 
of the nervous system, such as tumorous, inflammatory, traumatic, and vas- 
cular lesions. The primary or idiopathic form is as yet insufficiently under- 
stood, but appears to be a separate entity with a characteristic evolution of 
symptoms and signs. 

In the orthostatic syndrome, presyncopal symptoms are prominent 
but sometimes of very brief duration. Autonomic manifestations such as 
nausea, pallor, and perspiration are often absent. Occasionally, convulsive 
twitching can be observed during the faint. In the recumbent position. 



Medical News Letter, Vol. 43, No. 2 7 

cerebral circulation is quickly restored and consciousness returns. In severe 
orthostatic hypotension, syncope raay occur so frequently as to preclude 
assumption of the upright position. 

Syncope Associated with Cardiac Dysfunction 

There are four major groups of cardiac abnormalities giving rise to syncope: 
cardiac arrhythmias, ischemic heart disease, valvular heart disease, and 
congenital anomalies of the heart- In the presence of such disorders, cere- 
bral blood flow and oxygen delivery to the brain niay be seriously impaired. 
The lesion causing cardiac dysfunction can be situated in the heart itself or 
elsewhere in the body, influencing the heart on a reflex basis. 

The onset of cardiac syncope is usually more rapid than the onset of 
other types of fainting. In fact, it may be so sudden that there seem to be no 
premonitory symptoms. If they do occur, they consist of varying degrees of 
dizziness, nausea, blurring of vision, and cardiac distress. The offset of 
the syncopal spell may also be rapid and in general the patient is not left with 
lingering postsyncopal discomfort. A fairly high proportion of patients with 
cardiac syncope exhibit minor convulsivernovements during the spell, One of 
the characteristics of cardiac syncope is that it may occur when the patient is 
in either the recumbent or the upright position. 

Syncope Caused by Cardiac Arrhythmias (Primary and Reflex) . In the 
primary group belong the excessively fast and slow heart rates which may 
result in syncope from severely reduced cardiac output or from asystole 
during delay in transition from one rhythm to another. Any of these disturb- 
ances iji rhythm may be transitory and are not necessarily found at a 
subsequent examination. In the paroxysnnal auricular and ventricular arrhyth- 
mias (tachycardia and fibrillation) syncope may occur at the onset, in the 
midst, or at the offset of the attack. Heart rates in excess of 180 to 200 per 
minute will generally be necessary before consciousness becomes clouded or 
lost. Many patients, however, can tolerate such accelerated heart rates with- 
out significant subjective discomfort. 

The faint in patients with excessively slow heart rates is secondary to 
damage of the atrioventricular conduction system with partial or complete 
heart block (Morgagni-Adams-Stokes syndrome). The duration of the asystole 
necessary to produce syncope varies from 5 to 15 seconds depending, to some 
degree, upon the patient's position (4,5). The lesion responsible for the car- 
diac arrhythmias may interrupt the structural integrity of the heart perma- 
nently, or the defect may be reversible as in toxic processes or temporary 
ischemia. 

Carotid Sinus Syncope . Among the disorders leading to cardiac syn- 
cope on a reflex basis, hyperirritability of the carotid sinus has been of 
special interest in the last few years. Digital stimulation of one or both 
carotid sinuses often leads to a reflex fall in blood pressure, slowing of 
teart rate, or both, and may be accompanied by mild dizziness and faint- 
ness. In some individuals, symptoms and cardiovascular signs are 



Medical News Letter, Vol. 43, No. 2 

profound, in which event the disorder is spoken of as "hyperirritable 
carotid sinus reflex. " This occurs mostly in elderly patients, the major- 
ity of whom have evidence of organic heart disease and atherosclerosis of 
blood vessels, A hyperirritable reflex has also been found in patients with 
neoplastic and inflammatory masses of the neck, trauma to the region of 
the carotid sinus, and digitalis intoxication, while symptoms of dizziness 
and faintness are readily obtained by stimulation of a hyperirritable sinus, 
loss of consciousness is rare. It may rarely be initiated by turning the 
head, wearing a tight collar, or shaving. As a rule, prodromal symptoms, 
if present, are of short duration consisting of dizziness, faintness and 
epigastric distress. Unconsciousness is brief. 

Three types of carotid sinus syncope are discussed. The most common 
is the "cardioinhibitory type, " in which vagal slowing of the heart occurs 
and the blood pressure falls. The second, the "vasodepressor type, " seems 
to be rare; it results from a drop in blood pressure without change in the 
cardiac rate. In many ways, this type is sinniiar to vasovagal syncope 
but occurs on stimulation of the carotid sinus and affects primarily the 
older age group. 

According to Weiss and Baker (6), there is a third type, the "cerebral 
type" of carotid sinus syncope which is not accompanied by either blood 
pressure fall or cardiac changes. In recent years, the existence of this 
cerebral form has been seriously disputed. Like others (7, 8), the authors 
could not convince themselves that such a type actually exists. They tend 
to agree with those who suggest that unconsciousness occurs on the basis 
of compromised cerebral circulation from digital irritation or obstruction 
of the carotid artery when the test for hypersensitive carotid sinus reflex 
is carried out. 

Glossopharyngeal-Vagal Syncope . An interesting, though rare, type 
of reflex syncope is that associated with glossopharyngeal neuralgia 
(9, 10). Fainting occurs concomitantly with pain that affects the base of 
the tongue, the pharynx, tonsillar area, and the ear. An electrocardio- 
gram recorded during a syncopal spell discloses bradycardia or asystole, 
Complete relief of pain and syncope is usually obtained by sectioning the 
glossopharyngeal nerve. It has been suggested that the cardiovascular 
effects of the syndrome are attributable to excitation of the dorsal motor 
nucleus of the vagus nerve by way of secondary afferent collateral from 
the nucleus solitarius, producing asystole through vagal inhibition (10). 

Other types of reflexly induced syncope, mediated through the vagal 
system, have occasionally been described in pharyngeal, esophageal, 
laryngeal, bronchial, and mediastinal lesions, during bronchoscopy and 
esophagoscopy, "needling" of body cavities, following ocular pressure, 
and in digitalis intoxication. 

Also, pleural and pulmonary processes, such as pulmonary embolism, 
have been said to be associated with syncope. Loss of consciousness is 
usually abrupt in onset and of short duration. In clinical practice, these 
forms are exceedingly rare. 



Medical News Letter, Vol. 43, No. 2 9 

Syncope Associated with Ischemic Heart Disease . In coronary insuf- 
ficiency, syncope is provoked by exertion and is preceded by dyspnea and 
anginal pain {11). Unconsciousness may last for many minutes and may be 
accompanied by convulsive twitching. If syncope accompanies myocardial 
infarction, it usually occurs at the onset, being associated with peripheral 
circulatory failure. Myocardial infarction should always be suspected in a 
patient in whom low blood pressure, weak pulse, pallor, and sweating per- 
sist for a long time after syncope. 

Syncope Associated with Valvular Heart Disease . Aortic stenosis is 
the most common offender in this group. Syncope occurs in 10% to 25% of 
cases and is almost always induced by physical activity (effort syncope). The 
syncopal spell is ushered in by dyspnea, weakness, dizziness, and angina 
pectoris (12). The cause for the faint is believed to lie either in inability to 
increase cardiac output with exertion (12), a hyperactive carotid sinus reflex 
(13), or a vasovagal reflex elicited by pressure changes in the heart (1). 
Rarely, mitral stenosis gives rise to syncope because of a markedly decreased 
cardiac output or a ball-valve type of thrombus. Myxomas of the auricles 
likewise are known to act as ball-valve obstructions and may cause syncope. 

Syncope Associated with Congenital Heart Disease . Transient loss of 
consciousness has been most commonly observed with the tetralogy and pen- 
talogy of Fallot, but may occur also intruncus arteriosus, Eisenmenger's com- 
plex, pulmonary stenosis, transpositionof the great vessels, and ventricular 
septal defects. Usually, it becomes manifest in early childhood and is precipi- 
tated by physical activities. Especially, the little patients with tetralogy of 
Fallot quickly learn that certain positions, such as squatting, will help allevi- 
ate an attack. This maneuver improves venous return to the heart and elevates 
systemic arterial pressure. Stead (14) has suggested that the insufficient 
arterial oxygen saturation causes cerebral hypoxia and produces the faint. 

Syncope Associated with Primary Pulmonary Hypertension 

This, too, is characteristically an effort syncope. Dresdale and colleagues 
(15) found it in 20% of their patients with this disease. Often, it is preceded 
by dizziness, epigastric distress, and faintness, and may be followed by nau- 
sea, vomiting, and abdominal cramps (15, 16). The attacks last from a few 
seconds to several minutes. Effort syncope is highly suggestive of primary 
pulmonary hypertension if the patient is found to have dilation of the pulmon- 
ary artery, accentuation of the pulmonary second sound, or right ventricular 
hypertrophy. The cause for the faint seems to lie in impaired cardiac output 
(14) which may fall to levels at which compensatory vasoconstriction is not 
able to maintain sufficient arterial pressure (1), 

Syncope Associated with Involvement of the Cerebrovascular System 

In cerebrovascular diseases as a group, fainting is an uncommon clinical 
manifestation. When it occurs, there is usually partial occlusion of some of 



10 Medical News Letter, Vol. 43, No. 2 

the large vessels of the neck. The more severely these vessels are affected, 
the more likely will syncope be a part of the clinical pictare. This general 
rule is best exemplified in the "aortic arch syndrome" (pulseless disease) 
in which occlusive vascular processes involve the aortic arch and markedly 
narrow the ostia of its main branches including the innominate, subclavian, 
and common carotid arteries. Syncope occurs in as high as 40% of these 
cases (17) and is characteristically induced by physical activity. It is often 
preceded by lightheadedness, blurring of vision, and confusion. 

Stenosis or occlusion of the vertebral arteries has been held respon- 
sible for those syncopal attacks occurring in relation to certain positions of 
the head, especially hyperextension and lateral rotation. Fainting in patients 
with the Klippel-Feil syndrome (18, 19), a congenital deformity of the upper 
cervical spine occasionally associated with an anomaly of the spinal cord, 
has been explained on that basis. Unterharnscheidt and co-workers (20) 
observed patients in whom, on turning the head, a symptom complex could be 
elicited consisting of piercing neck pain, a hot flush radiating into the head, 
nausea, possible vomiting, vertigo, visual scotomas, and finally, unconscious- 
ness. They reported having observed such a syndrome in degenerative cervi- 
cal arthritis and after trauma to the cervical spine. 

In occlusive disease of the carotid artery systenn, recurrent syncope 
is rare and probably occurs only when the disease is bilateral unless there 
is superadded hypersensitivity of the carotid sinus. Webster and Guardjian 
(21) have been using syncope provoked by digital compression of the carotid 
artery as a diagnostic sign of occlusive vascular disease. They maintain 
that if syncope can be induced by manual compression of the carotid artery 
on the side of the neurologic symptoms and signs, occlusive disease of the 
contralateral carotid or anterior cerebral arteries exists. They also noted 
that syncope occurred upon both right and left carotid compression in patients 
with occlusion of the basilar artery. The hazards of such tests are thought by 
many — including the authors — to outweigh the diagnostic advantages. Brief 
mention should be made of the acute hypertensive encephalopathy in which 
syncope has been reported as occurring as part of the transient alterations of 
cerebral function and as lasting from minutes to hours, 

Pressor-Postpressor Syncope 

Symptoms such as lightheadedness and blurring of vision are seen in some 
individuals during strenuous activities such as laughing, coughing, straining 
at stool, vomiting, sneezing, and lifting. Occasionally, these symptoms may 
culminate in syncope. Best known is "tussive syncope, " the faint accompany- 
ing an attack of coughing. This affects almost exclusively men after the age 
of 40 years who are of pyknic or athletic habitus and capable of considerable 
muscular effort. Chronic bronchopulmonary disease may be a predisposing 
factor. The attack is initiated by a series of strenuous expiratory coughs 
without inspiratory relief and is not necessarily prolonged. The face of the 
patient becomes congested, his eyes tear, he seems to be dazed, and finally 



Medical News Letter, Vol. 43, No. 2 11 

at the height of the coughing attack or at its cessation, he slumps to the floor 
unconscious and may display convulsive twitching. Recovery is prompt. 
These attacks may occur when the patient is in the erect or recumbent position. 
The cause of tussive syncope and other pressor symptoms is believed to lie 
in the greatly increased intrathoracic pressure which results in decreased 
venous return to the heart, diminution in cardiac output, com,promised intra- 
cranial circulation and cerebral anoxia (22, 23), 

Breath -holding spells are thought to arise on a similar pathophysio- 
logic basis. They occur generally in children between 2 and 5 years old and, 
as a rule, are precipitated by emotional stimuli such-as fear and frustration. 
At the end of a vigorous period of crying, the child holds his breath in pro- 
longed expiration. Suddenly his eyes roll up and he turns deeply cyanotic and 
loses consciousness. He may have brief twitching and incontinence of urine. 
Within seconds, the normal state is restored except for occasional transient 
lethargy. 

Micturition Syncope 

This is said to occur just before, during, or right after urination in the 
upright position; the person affected has almost always been recumbent for 
some time. It has been suggested that this type of fainting is caused by a 
circulatory collapse that occurs when the postural adaptive mechanisms are 
not allowed their usual period of adjustment (24). Vasomotor reflexes from 
the bladder itself have also been thought to play a contributing part. Conscious- 
ness is said to be lost abruptly or after symptoms, such as dizziness, weak- 
ness and nausea, and injuries have been sustained. This type of syncope, 
the authors believe, is rare and it is doubtful whether it constitutes a separate 
entity. More likely it represents a simple postural faint. 

(To be continued) 

References 

1. Shai-pcy-Sthafer, E. P.: Enitlgencies in General PrHclice: Syniope. Brit. M. J. /.-506-509 

(Mar. 3) 195fi. 

2. Edholm, 0. G.: Physioiogiral Changes During Fainting. In Wolstenhulme, G. E. W.: Vis- 

ceral Circulation. Boston, Little, Brown and Company, 1<)53, pp. 256-267. 
i. Thomiss, i. E., Schirger, Alcsaniler. and Mnlnai-. G. D.: Orthostatit Hypotension; A Cliniul 
Review. !. Indian M. Profession (In press.) 

4. Engel, G. L. : Fainting: Physlologiral and PsyrholijgLrai Considerations. Ed. 1. Springfield, 

f;harles C Thomas, Publisher, 1950, 141 pp. 

5. Gastaut, H., anil Fisiher- Will lams. M,: Eleitrii-encephalographir Study of Syncope: Its 

Differentiation From Epilepsy. lancet ^.1018-1025 (Not. 23) 15157. 
6- Weiss, Soma, and Baker, J. P.: The Carotid Sinus Reflex in Health and Disease: Its Hole 
m the Camati.jn of Fainting and Convulsions, Medicine .r2,-29;-35+ (Sept.) 1933. 

7. Gurdjian, E. S., Webster. J. E., Ilaidy, W. G., and Lindner, D. W. : 'Nonexistence of the 

So-Called Cerebi-al Form of Carotid Sinus Syncope. Neurology S,-818-824, 1958. 

8. Gastaut, Henry, Vigouroux, Robei-t, and Dell, M. E.: Polygraphic Study of Carotid Sinus 

Hypersensitivity Produced by Extra-Sinus Stimulation (Compression of the Carotid Sinus). 
In: Cerebral Anoxia and the Electrnencepiialogram, Sprmgfield, Illinois, Charles C Thomas 
Publisher, 1961, pp. 485-507. 
0. Svien, H. J., Hill, N. C, and Daly, D_ D.: Partial Glossopharyngeal Neuralgia Associated 
With Syncope. J. Neurosurg. 14:462-457 (July) t<>57. 

10. Garret.son, H. D., and Elvidge. A. B, : Glossopharyngeal Neuralgia With Asystole and 

Seizures. Arch. Neurol. il-2fi-31 (Jan.) 1963. 

11. Golden. Abner: Syncope Associated With Exertional Dyspnea and Angina Pectoris Am 

Heart J. 2«.(>89-698 (Dec.) 19++. 

12. Hammarsten, J. F.: Syncope in Aortir Sfenosis. Arch. Int. Med. *7;274-279, 1951. 

13. Marvin, H. M.. and Snllivan, \, G.: Clinical Observations Upon Syncope and Sudden 

Death in Belation to Aortic Stenosis. Am. Heart J. /ftr05-735 (Aug.) 1933. 

14. Stead, E. A.: Fainting. Am. J. Med. /!.-387-390, 1952. 



X2 Medical News Letter, Vol. 43, No. 2 

FAINTING ( Continued) 

References 

15 Dresdale, D. T., Scliulta, Martin, and Mkhtnin, B. J.: Primary P"lm0"ai7 Hypertension: 

I. CliT.;)-=I and Hemodynamic Study, Am. J. Med. //.-fiSfi-ZOS (Def,.l 1951. 

16 Dressier William- Effort Syncope as an Early Manifestation of Primary Pulmonary HyjKT- 

lension. Am. J. M. Sc. 323.13M+3, 1952. 
1?. Cuirier, R. D., DeJong, H. N., and Bole, G. G.; Pulseless Disease: Central Nervous 
System Manifestations. NeurtJogy -f.-SlS-SJO, 1954. 

18 Illingworth R S ■ Attacks of Unconsciousness in AssociatiiHi With Fused Cervical Vertebrae. 

Arch. Dis! Childhood 3/:8-ll (Feb.) 1956. 

19 Denny-Brown, D.i Recumnt Cerebrovascular Episodes. Arch. Neuiol. 2.19+-210 (Feb.) 1960. 

20 Untsrbamscheidt, Friedrich, Rohr, Hans, and Decher, Hellmuth: Das nichttraumatische 

synkopale cervicale Vertebralissyndrom. Nervenarzt JO.-310-3I5 (July) 1959. 

21 Webster J. E., and Gurdjian, F. S.: Observations Upon Responses to Digital Carotid Artery 

Compression in Heraiplegic or Hemiparetic Patients. Neurology ?.- 757-762, 195?. 

22 Mcintosh H D, Estes, E. H., and Warren, J. V.: The Mechanisms of Cough Syncope. 

Am. Heart J. 52.70-82 (July) 1956. 

23 Sharpey-Schafer, E. P. : The Mechanism of Syncope After Coughing. Brit. M. J. 2:B60-SS* 

(Oct. 17) 1953. 

24 Lvle C B Jr Monroe, J. T., Jr., Flinn, D. E., and Lamb, L. E.: Micturition Syncope: 

Report of 2+ Casps. New Enuland J. Med. 2^1-982-986 (Nov. 16) 1961. 

:{!: si: $ :tc 4: :{c 

Filariasis of the Testis - A Case Report 

CAPTW. E. Fraser MC USN, Chief of Urofegy; U.S. Naval Hospital, 
Bethesda, Md. , and CDR L. A. Jachowski Jr. MSC USN, Parasitology 
Department, Naval Medical Research Institute, Bethesda, Md. 

A 33 -year old Marine officer was admitted to the Urology Service, U. S. Naval 
Hospital, Bethesda, on 3 August 1963 for scrotal exploration. A small pain- 
less nodule associated with the right testis had been discovered by the patient 
48 hours prior to admission. Findings of the physical examination were nor- 
mal except for a left inguinal scar and the small mass related to the right 
testis. At operation, a small cystic mass attached to the tunica vaginalis 
was excised. 

Examination of sections of the specimen revealed one or more worms, 
identified as filariae, in the cyst (Figure 1). Blood smears were then taken 
at 1200 and 2400 hours. They did not contain microfilariae. A serum sample 
was reactive {titer 1:8) to a filarial antigen in the slide flocculation test. Past 
history of the patient included tours of duty in Korea (1953-1954) and in 
Okinawa (1962-1963), "While stationed in Okinawa, he also spent one week in 
the Philippines and two months in Japan. In Okinawa, his duties included fre- 
quent night maneuvers. Except for recent symptoms of cystitis, the history 
was noncontributory. The patient had no clinical manifestations of filariasis 
and received no antifilarial treatment. Recovery from surgery was rapid 
and uneventful. 

Discussion 

The patient was admitted with a provisional diagnosis of neoplasm, testis. 
Surgical treatment was definitely indicated because a high percentage of 
nodules of the testis are malignant (1). Evidence suggests that the infection 



Medical News Letter, Vol. 43, No. 2 



13 



probably was acquired while the patient participated in night maneuvers in 
Okinawa. First, Wuchereria bancrofti , which frequently causes genital lesions, 
is endemic on the Island. It does not occur in those areas of Japan and the 
Philippines visited by the patient. Also, this was not an old infection. The 
worms in the section had been viable at the time the nodule was preserved. 
Moreover, sections through the uterus of a worm showed developing micro- 
filariae, yet no microfilariae were detected in blood smears. 

Figure 1 

Section of Nodule Showing Sections 
of Adult Filaria Worms 




This case closely parallels one described by Borski and Tipton (2). Their 
patient was an Arnny technician who also had a painless nodule in the testis. 
The pathologic diagnosis was filariasis. Thus, in servicemen with histories 
of overseas duties, filariasis must be considered as one of the causative 
agents of benign lesions of the testis. 

References 

1. Kimbrough, J. C. and Borski, A. A., 1953. Treatment of tumors 
of testes. Southern Med J 46:386-490, 

2. Borski, A. A. and Tipton, R. R, , 1958. Filariasis of testis. U.S. 
Armed Forces Med J 9(5):740-744. 



;!; ^ ^ ;}! ^ ^ 



14 Medical News Letter, Vol. 43, No. 2 



FROM THE NOTE BOOK 

The following message from President Johnson has been received from the 
Office of the Under Secretary of the Navy, The Honorable Paul B. Fay Jr. 



A Message fronn President Johnson 

'Memorandum to Heads of Departments and Agencies: 

I ask that you convey this personal message to all of your employees; 

In these first days, men and women of all ranks within the governnnent 
have asked me, 'What can I do to help?' Many more of you, deeply 
committed to the Federal service, are undoubtedly asking yourselves 
the same question. It is inripossible for me to make a direct and per- 
sonal response to all of you, much as I would like to do so. Yet there 
is an answer which I would like to express to every employee in every 
agency at every location in the Federal Government. It is simply this: 
Give your best to your job and your country. ' 

As your Chief Executive, I will do my utmost to maintain the high 
quality and character of the career service in the government and to 
advance its usefulness through improvement. I will look to those who 
direct the day to day activities of this great work force and to the 
Chairman of the Civil Service Commission for continuing reports and 
recommendations to assist me in this purpose. 

We have a great resource of abilities and talents among the people 
serving our Federal Government. We have career systems to assure 
continuity of people and programs. We are organized for the job and 
the work is before us. President Kennedy did not shrink from his 
responsibilities, but welcomed them, and he would not have us shrink 
from carrying forward the great work he began so well. I say to you 
as I said to the Congress; 'Let us continue'. " 

— TIO, BuMed, 30 December 1963 



Surgeons General of the Past 
By E. P. Kuhn J02 USN 

Charles Francis Stokes, eighteenth Chief of the Bureau of Medicine and 
Surgery and fourteenth Surgeon General of the Navy, was born in Brooklyn, 
New York on February 20, 1863. Before interning at Bellevue Hospital, he 
received his medical degree from the College of Physicians and Surgeons 



Medical News Letter, Vol. 43, No. 2 15 

in New York. On February 1, 1889, President Grover Cleveland signed his 
comn:iission and appointed him an assistant surgeon from New York. He was 
first assigned to the USS MINNESOTA which, at that time, was receiving ship 
at the New York Navy Yard, Then came duty at the U. S. Naval Hospitals at 
Mare Island and Yokohama, Japan. 

The Spanigh-American War found Doctor Stokes serving as operating 
surgeon on the USS SOLACE, the first of our hospital ships to fly the flag of 
the American Red Cross. In 1908, President Theodore Roosevelt sent the 
Great White Fleet on a cruise around the world. Included in the fleet was the 
hospital ship USS RELIEF commanded by the soon-to-be Surgeon General. 
On February 5, 1910, President Taft appointed him as Surgeon General of 
the U. S. Navy in which capacity he served until February 6, 1914. 

Admiral Stokes is best remembered as inventor of the Stokes stretcher 
which has been used throughout the Navy to this day. It has been of remark- 
able value in transporting sick and injured up and down narrow ladders and 
through small and otherwise poorly accessible areas. Examples of the latter 
are manholes and hatches aboard ship, firerooms, fighting tops, and turrets. 
Secured in this stretcher, a patient can be transferred by high line from one 
ship to another on the high seas or lowered into a boat in comfort and safety. 
Equipped with simple and ingenious fittings, the stretcher may be adjusted 
to combine splinting for fractures with the function of a litter for transporta- 
tion. For its many practical applications in wartime or peace, the Stokes 
stretcher has been copied by a number of foreign navies. 

Former Surgeon General Rixey had accomplished many advances to 
improve the efficiency of the Navy Medical Department, Admiral Stokes, as 
his successor, likewise pursued a vigorous progressive policy. High stand- 
ards were maintained for commission and active duty in the Medical Corps; 
only candidates who were graduates from excellent medical schools and who 
were capable of passing rigid physical and professional examinations were 
accepted. The newly commissioned Hospital Corps School at Norfolk, Va. , 
was utilized to the utmost in training Hospital Corps personnel; a majority 
of chief pharmacists of the Navy for many years were alumni of this school. 

During Surgeon General Stokes' administration, the U. 3. Naval Hos- 
pital, Pearl Harbor was planned and constructed. In addition, plans were 
laid down for construction of the USS RELIEF, the first vessel to be designed 
and built as a hospital ship from the keel up. Previously, these ships had been 
converted from liners. 

On the evening of May 5, 1913, in the New Willard Hotel, Washington, 
D. C. , more than three hundred distinguished surgeons from the United States 
and Canada gathered by special invitation to discuss the formation of a new 
surgical organization to be called the American College of Surgeons. Before 
the evening was over, the College had been founded, ground rules for Fellow- 
ship had been established, and Officers and the Board of Regents elected. 
Surgeon General Stokes was a member of that first Board of Regents, along 
with sixteen other illustrious surgeons who gave such great impetus to the 
development of modern aseptic surgery in the Western Hemisphere. 

Retiring in June 1917, Admiral Stokes lived in New York City where he 
died on October Z9, 1931. Interment was in Arlington National Cemetery. 



16 Medical News Letter, Vol. 43, No. 2 

Active Duty Officers Receive American 
Board Certifications 

American Board of Anesthesiology 

LT Charles P. Larson Jr, MC USNR 

American Board of Dermatology 

CDR Fred R. Edens MC USN 
LCDR William S. Brothers MC USN 
LT Rudolph J. Scrimenti MC USNR 

American Board of Internal Medicine 

LCDR Arnold 1. Meisler MC USNR 

American Board of Obstetrics and Gynecology 
LCDR John F. Wurzel MC USN 

American Board of Ophthalmology 

LCDR Charles P. Hodgkinson MC USNR 

LCDR James C. King MC USN 

LCDR Spencer F. Maddox Jr, MC USN 

American Board of Otolaryngology 

LT Lawrence R. Boies MC USNR 
LT Theodore J. Eckberg MC USNR 
LT John W. Sabatine Jr, MC USNR 
LT Dean H. ZoBell MC USNR 



American Board of Patholo 



II 



LCDR Jade R. Hayes MC USN 
American Board of Pediatrics 

LCDR Henry D. Knox MC USN 
American Board of Surgery 

LCDR Richard J. Miller MC USN 
LCDR Stephen J. Mucha MC USN 
LCDR Bernard S. Shapiro MC USNR 

American Board of Thoracic Surgery 

LCDR Ernest H. Meese MC USN 



Medical News Letter, Vol. 43, No. 2 



17 




MISCELLANY 



Space and Astronautics Orientation Course 

This course has been established to give senior officers of the Navy a better 
understanding of this new technology, its application to naval warfare, and 
its important. role in national defense. The course is in consonance with the 
Navy's global mission and emphasizes the significant impact of astronautics 
on seapower. It is primarily designed for those senior officers who have not 
had the opportunity to gain knowledge of astronautics and current Space pro- 
grams. A highlight of the course is a visit to the space vehicle launch and 
control facilities at Point Arguello Naval Missile Facility and at Vandenberg 
Air Force Base. 



Location : 

Duration of Course : 
Convening Dates of 
Course: 



BUMED Quota : 
Deadline Date to 
Apply : 

Eligibility: 



U.S. Naval Missile Center, Point Mugu, Calif. 
Four days (Tuesday - Friday) 



25 February 1964 
10 March 1964 
24 March 1964 

ONE for each class 

Immediately for the 25 February course, and 
6 weeks in advance for the remaining courses. 

Rank of Commander and above. TOP SECRET 
security clearance required. 



In view of the shortage of travel funds for Fiscal Year 1964, only a limited 
number of officers can be authorized to attend these courses on travel and 
per diem orders chargeable against Bureau of Medicine and Surgery funds. 
Eligible and interested officers who cannot be provided with travel orders to 
attend at Navy expense may be issued Authorization Orders by their Com- 
mianding Officers following confirmation by this Bureau that space is available 
in each case. Requests should be forwarded in accordance with BUMED 
INSTRUCTION 1520. 8 and comply with the deadline dates indicated above. 
All requests must indicate that a security clearance of TOP SECRET has been 
granted to the officer requesting attendance, and if Bachelor Officer's 
Quarters are desired. — Training Branch, Professional Division, BuMed. 



18 Medical News Letter, Vol. 43, No. 2 



Military Sargeons Convene 

Rear Admiral Calvin B. Galloway MC USN, Commanding Officer of the 
National Naval Medical Center, Bethesda, Md. , has completed his term of 
office as President of the Association of Military Surgeons of the United States. 
His successor is Colonel Robert C. Kimberly MD Md NO of Baltimore, Md. 
Rear Admiral Robert B. Brown MC USN was General Chairman of the Com- 
nnittee on Arrangements for the 70th Annual Meeting of the Association held 
at the Statler -Hilton Hotel, Washington, D. C. on 4, 5, and 6 November 1963. 
Captain Paul L. Austin MSC USN was Assistant to the General Chairman. 
Captain John R. Seal MC USN was Chairman of the Scientific Program 
Committee. 

The theme of the meeting was "Medical Research Today - Military 
Resource Tomorrow. " Many leaders in the Federal medical services and 
civilian medicine of the United States made presentations and participated 
in panel duscussions on the varied aspects of military medicine, dentistry, 
veterinary medicine, pharmacy, and the paramedical sciences. On the opening 
nnorning "Panel of Chiefs of Federal Medical Services, " an address on the 
research programs of the Navy Medical Department was delivered by Rear 
Admiral Edv/ard C. Kenney MC USN, Surgeon General of the Navy. Other 
speakers on the panel were the Honorable Shirley C. Fisk MD, Deputy 
Assistant Secretary of Defense (Health and Medical); Brigadier General 
Conn L. Milburn MC USA, Deputy Surgeon General of the Army (represent- 
ing LT General Leonard D. Heaton MC USA, Surgeon General of the Army); 
Major General Oliver K. Niess MC U.S. Air Force, Surgeon General of the 
Air Force; Luther L. Terry MD, Surgeon General of the U.S. Public Health 
Service; and Joseph H. McNinch MD, Chief Medical Officer of the Veterans 
A dmini s t r ati on , 

One of the prominent and colorful features of the convention was the 
convocation in honor of the international delegates, representing the armed 
services medical departments of NATO and SEATO nations. This event was 
followed by the International Luncheon presided over by Admiral Galloway 
who introduced the guest speaker, Rear Admiral Lloyd V. Berkner, U. S. 
Naval Reserve, BS, D Eng, PhD, LL D, President, Graduate Research Center 
of the Southwest, Dallas, Texas. Admiral Berkner gave a brilliant talk on 
"Medical Science - Its Place in the Scientific Revolution" which was received 
with great enthusiasm. 

Honors and Awards 

Sir Henry Wellconne Medal and Prize . A silver medal, scroll, and honorarium 
of $500 are awarded for the best essay on a subject pertaining to military 
medicine. Recipient: Captain Sidney I. Brody MC USN, Staff Medical Officer 
2nd Marine Aircraft Wing, Station Hospital, Marine Corps Air Station, Cherry 
Point, N. C. The essay was entitled, "Sore Throat of Myofascial Origin. " 



Medical News JLetter, Vol. 43, No. 2 19 

The Founders' Medal is awarded for outstanding contributions to military 
medicine and distinguished service to the Association. Recipient: Rear 
Admiral Robert B. Brown MC USN, Assistant Chief of the Bureau of Medicine 
and Surgery for Personnel and Professional Operations: and Captain John R. 
Seal MC USN, Commanding Officer, Naval Medical Research Institute, National 
Naval Medical Center, Bethesda, Md, 

The Andrew Cralgie Award is named in honor of the first Apothecary General 
of America's military forces who served under General George Washington 
during the Revolutionary War. This award consists of a plaque and an honor- 
arium of $500, and is given in recognition of outstanding accomplishment 
in the advancement of professional pharmacy in the Federal Government. 
Recipient: Commander John J. Beretta MSC USN, Defense Medical Supply 
Center, Brooklyn, N.Y. 

The William C. Porter Lecture was established to honor a pioneer in military 
psychiatry. The 1963 lecture was given by Captain Ralph L. Christy MC USN, 
Chief, Neuropsychiatric Branch, Professional Division, Bureau of Medicine 
and Surgery, on the subject, "The Vital Role of the Military Medical Officer 
in Support of Command and the Military Mission. " 

^ ^ ^ $ $ :;: 

Naval Medical Officers Assist in Joint 
USN-IIN Civic Action Operations 

The USS STRONG of Destroyer Squadron Four and based in Charleston, S. C. 
participated in Joint U.S. Navy-Imperial Iranian Naval Civic Action opera- 
tions, 24 November - 1 December 1963 while serving a tour in the Red Sea- 
Persian Gulf Area under operational control of Commander, Naval Forces, 
Middle East. The Operation was conducted in the company of the Irhperial 
Iranian Naval Frigate BABR. 

The Iranian Civic Action is continuing the program under the Director, 
Iranian SUPREG Commander. Efforts are coordinated with governments, and 
civic and charitable organizations and agencies assisted by Charmish, Mil- 
itary Assistance Advisory Group, U.S. Aid, and CARE. The need for this 
joint operation stemmed from effects of prolonged drought, paucity of trained 
medical personnel and facilities, and relative inacessibility (except by sea) 
of southern coastal towns and islands. Due to consecutive drought years, 
there were crop failures, starvation of livestock, and widespread malnutrition. 

In early October, LT Michael D. PoUane MC USNR embarked on the 
USS STRONG with nearly two tons of medical supplies provided by the Bureau 
of Medicine and Surgery, Department of the Navy, Washington, D. C. , Operation 
Handclasp, and World Medical Relief, Inc. LCDR S. J. Kendra MC USN of the 
Preventive Medicine Unit in Naples reported to the STRONG at Karachi, Paki- 
stan for temporary additional duty on 23 November 1963. 



20 Medical News Letter, Vol. 43, No. 2 

The STRONG joined the Imperial Iranian Ship BABR on 24 November 
at Chahbahar and embarked Dr. Sydney Thomas and Dr. Bruce Jessup. The 
medical personnel organized into three teams employing maximum medical 
diversity. The initial survey of population centers was to determine medical 
needs and establish clinics to administer aid and distribute medical supplies. 
The team of doctors treated approximately 1200 in Chahbahar. The most 
serious nnedical conditions were noted in children under 12 years of age, 
including malnutrition and trachoma. STRONG and BABR departed Chahbahar 
on 25 November and arrived in Jask on 26 November. Due to shallow beaches, 
rubber life rafts were used to land supplies; on one occasion, doctors were 
carried ashore on the shoulders of native porters. Using a newly constructed 
but unmanned and unequipped hospital building, the doctors and hospitalmen 
set up a Pediatric tent and Internal Medicine and Surgical Clinics. 

Two other medical teams visited nearby villages. Old Jask, Yekbugi, 
Yekda, and Bahar. The ship departed Jask on 27 November and arrived at 
Bandar Abbas — a city of approximately 10,000 — on 28 November. The teanris 
assisted limited medical facilities in the city; these included five local phy- 
sicians and hospital. They visited off-shore islands of Hormuz, Laral, and 
Qeshm. In addition to medical assistance, representatives of Federal Lion 
and Sun Society, Iranian — equivalent to the American Red Cross and CARE — 
assisted by Iranian Naval personnel, distributed food and clothing. Handclasp 
dolls, English text and library books, and Navy League kites were presented 
to school children. STRONG personnel repaired an inoperable X-ray machine 
and operating-room air conditioners at the Bandar Abbas Hospital where the 
temperature reaches ISO^F. Other crewmen repaired electrical wiring, 
replaced window screens, and repainted the Girls High School. 

At a conference concluding the Operation, Governor General Nawab, 
Governor of the Southwestern District of Iran, expressed pleasure at the 
success of the Operation and considered the dedication of United States per- 
sonnel — even in the time of mourning — a fitting memorial to the late President 
John F. Kennedy. General Eckhart USA, Charmish, Tehran, in commending 
USS STRONG for their part in this Operation, said, "Medical treatment to 
approximately 5190 Iranians during this trial Operation constitutes a new 
milestone in the joint US/Iranian Civic Action Program. " 

LT Pollane was born in New York City in 1938. He received his BS 
from Georgetown University, Washington, D. C. , in 1958 and his M D in 1962. 
He served his internship at Meadowbrook Hospital, Hempstead, L.I. , N. Y. , 
and was commissioned LT MC USNR on August 7, 1963 from the Naval 
Recruiting Station, New York, N. Y. — Technical Information Office, BuMed 

J, *l» iff -Jf ^tf A 
^f* *f* >l'^ ^Ip ^f^ ^f* 

Health Problems of the Americas . In Latin America, one child in 
seven dies before reaching the age of five, the nnajor causes of death 
being protein-calorie malnutrition and the diarrheal diseases. One of 
the aims of a ten-year public health plan recently adopted for the 
Americas is a 50% reduction in infant mortality by 1970. 

— WHO Chronicle, November 1963 



Medical News Letter, Vol. 43, No. 2 21 

Soaps Versus Detergents - A Warning 

The following statement is taken from the National Clearinghouse for Poison 
Control Centers, DHEW, November - December 1963. 

For some time, the National Clearinghouse has refrained from 
advocating the use of soap or soap-suds for induction of emesis. 
This negativity was not the result of a judgment on the effective- 
ness of soap-suds, but out of apprehension that there could be 
confusion between "soaps" and "detergents. " Reports received 
at the National Clearinghouse on the accidental ingestion of deter- 
gents, for the most part, have not shown any serious effects, 
nor have they shown proficiency in producing vomiting. On the 
other hand, some household cleaners, including dish"washing 
machine detergents, ixiight cause serious injury if confused with 
what has become the generic name of "soap. " 

Recently, several reports have been received in which detergents 
were administered when soap-suds enemas were prescribed. It is 
believed that this type of error could produce significant injury. 
Again, without judging the effectiveness of soap-suds enemas, 
the National Clearinghouse would like to caution those physicians 
prescribing them to give patients very specific instructions in 
preparing such enemas. —Medicine Branch, ProfDiv, BuMed 

:J: 5|« s;; s): Sf: ^s 

First Training Program for Psychiatric -Mental 
Health Nursing Research at NYU 

The department of nurse education of New York University's School of Education 
has received a grant from the National Institute of Mental Health to establish 
the nation's first training program for research in psychiatric -mental health 
nursing. The primary function of the program will be developnment of nurse- 
researchers and contribution of new knowledge to psychiatric -mental health 
nursing. Activities, including seminars and conferences, will be planned this 
year under an initial grant of $18, 534 from the Institute. 

Mrs. Florence Downs, Director of the program, explains that "The 
complexity of knowledge and skills essential to fulfilling current dimensions 
of nursing practice demands principles arrived at by scientific research, 
A concept of nursing as a learned profession is replacing the traditional con- 
cept of nursing as 'doing. ' " 

Sixty-four doctoral candidates are enrolled in the department of nurse 
education, of whom twenty-one are majoring in psychiatric -mental health nurs- 
ing. Twenty-six master's degree candidates also are enrolled in this field of 
study, 

4 ^ :}: >^ :{« :ic 



22 Medical News Letter, Vol. 43, No. 2 




DEIMTAl I oM^ 11 SECTIOIV 



Va riations of the Typical Amalgam Preparation 

Henry E. Fayle Jr. D D S, University of Texas, Dental Branch, Houston, 
Texas. J Pros Den 13(6): 1147-1150, November-December 1963. 

Since there are variations in the amount of tissue destruction in individual 
teeth, the location of carious lesions, the alignment of teeth in the arch, and 
the level of the marginal gingiva, there must be some variation from the typi- 
cal amalgam preparations for these teeth. iTiis -article describes modifications 
of the classical amalgam cavity preparations which fulfill the requirements 
for these special situations. 

Undermined Cusps . Advanced caries often destroy the dentin under- 
lying cusps, often making it necessary to remove one or more of the cusps 
partially or completely. When cusps are restored with amalgam, it is im- 
portant to make sufficient reduction of the tooth to provide for at least 2 mm 
thickness of the amalgam in the restoration. This thickness is necessary for 
adequate strength. Whenever possible on a proximoocclusal preparation, the 
reduced cusp portion should be at a higher level than the pulpal wall (Fig. 1). 
This provides support for the matrix band and insures a full contour of the 
restoration. Three important factors in the restoration of a cusp with amalgam 
are: (1) sufficient reduction of the cusp (minimum of 2 mm} must be made; 
(2) the pulpal floor of the reduced cusp should be parallel to the direction of 
the enamel rods; and (3) no bevels should be used in the preparation. ( 1, 2) 

If the entire lingual or buccal cusp of a bicuspid or the lingual or buccal 
cusp of a molar must be restored, pins should be used for reinforcement (3), 
(Fig. 1). If pins are used, the great danger is not so much in pulp exposure as 
it is in perforating the tooth below the level of the gingiva. While a depth of 
3 to 4 mm for pins has been advocated (4), the author feels that a depth of 1. 5 
to 2 mm is adequate and safe. 

Caries At The Tip of the Cusp. Dental caries may occur on the tip of 
a cusp. There is a tendency to obtain retention in these teeth by undercutting 
the walls of the preparation. This may leave unsupported enamel rods. Eventu- 
ally, the unsupported enamel rods will fracture, leaving a rough, ditched margin. 

The cavity must be prepared in the dentin. The cavity walls should be 
tapered in the same direction as the enamel rods. Then, for retention, a small 
inverted cone bur is used to undercut the base of the cavity which is in dentin 
(Fig. 2). 



Medical News Letter, Vol. 43, No. 2 



23 



Malposed Teeth . An ideal Class II amalgam preparation cannot always 
be prepared on a tooth which is in buccal or lingual version or rotated in the 
dental arch. The preparation must be varied to bring one proximal wall into 
a self-cleansing area and to keep the other proximal wall from being extended 
too far into the embrasure. If the tooth is in lingual version, the proximobuccal 
wall must be extended farther toward the buccal surface of the tooth than usual. 
To avoid weakening the tooth {and the restoration), the proximolingual wall is 
not extended as far toward the lingual surface as usual. When a tooth is in 
buccal version, the opposite modification is indicated; In the extension of the 
buccoproximal preparation on a tooth in lingual version, care mustbe exercised 
not to encroach on the pulp. This is done by cutting the wall at a slant, which 
is produced by extending the gingival wall more than usual, but without ex- 
tending the occlusal portion of the proximal part of the preparation much more 
than usual (Fig. 3). 





WITH PIN 
REINFORCEMENT 



WITHOUT PIN 
REINFORCEMENT 



Pig. 1. — ^The height of weakened cusps should be reduced to allow a thickness of at least 2 
mm. of amalgam for strength. The amalgam should be reinforced with pins when an entire cusp 
is to be restored. 



CORRECT INCORRECT 




CARIOUS LESIONS ON 
THE TIPS OF THE CUSPS 

Fig. 2. 




BUCCAL VERSION 

Fife'. 3. 



Pig. 2. — Caries on the tip of a cusp requires the cavity walls to be divergent so they are 
parallel to the enamel roas. The rtteulioii should be secured In the dentin. 

Fig, 3. — The cavity form for jnalposed teeth must be extended to relatively cartes-immune 
areas. 



Variations in Level of Marginal Gingiva . In teeth with normal gingivae, the 
gingival margin of a Class II preparation should be placed below the free margin 
of the gingiva. In patients with periodontal disease or advanced gingival re- 
cession this would not be practical. In these instances, the gingival margin of 
the preparations should be extended only far enough to avoid contact with the 



24 Medical News Letter, Vol. 43, No. 2 

adjacent tooth at the gingival margin, and to remove all of the caries (Fig. 4). 
The gingival margin of the preparation is occlusal to the gingiva in these situ- 
ations. 





CLASS 2 WtTH CLASS 2 WITH 

NORMAL GINGIVA GINGIVAL RECESStON 




CLASS 2 DO ON TERMINAL TOOTH 
WITH HIGH GINGIVAL ATTACHMENT 

Fig. 4. Above left. When the gingival height Is on a level with the cervix of the tooth, the 

Slnglval margin of the preparation should be within the gingival sulcus. Above right, When the 
gingival height la t>elow the cervix of the tooth, the gingival margin of the preparation should 
be occlusal to the gingiva. Below, A proximo-occlusal preparation on a terminal tooth with a high 
gingival attachment or deep gingival sulcus does not require a distal step. The pulpat wall Is 
extended to the distal surface of the tooth. 

Another variation is made necessary by the position of the marginal gingiva 
distal to a second or third molar when it is the terminal tooth in the arch and 
a disto-occlusal preparation is to be made in it. Often the gingiva is on a level 
with the occlusal surface of the tooth. If a typical disto -occlusal preparation 
is made with a proximal box and an occlusal step, the gingival wall is prepared 
far below the gingiva. Since there is no adjacent tooth, it is better to eliminate 
the step and extend the pulpal wall through the distal surface of the tooth. It 
is then possible to place the matrix on the tooth and cause little or no bleed- 
ing (Fig. 4). 

It is neither possible nor desirable to attempt typical cavity forms for 
all carious teeth. The location and extent of caries may require modifications 
of the standard amalgam preparation. Malposed teeth and variations in the gin- 
gival height also require deviations from the conventional preparation. This 
article illustrates some of the problems and offers solutions based on the basic 
fundamentals of good cavity preparation. 

References 

1. Simon, W. J. , editor: Clinical Operative Dentistry, Philadelphia, 1956, 
W. B. Saunders Company, pp Z3-24. 

2. Gabel, A. B. : The American Textbook of Operative Dentistry, ed. 9, Phila- 
delphia, 1954, Lea & Febiger, pp 297-298. 

3. Markley, M. R. : Pin Reinforcement and Retention of Amalgam Foundations 
and Restorations, JADA 56: 675-679, 1958. 

4. Roberts, E. W. : Crown Reconstruction With Pin Reinforced Amalgam, Texas 
DJ 81: 10-14, 1963. 

>[s ^ >St sj: 5): s[e 



Medical News Letter, Vol. 43, No. 2 25 

Personnel and Professional Notes 

Special Announcement to Dental Corps Contributors. On page 2 of each issue 
of this publication, the reader will find a statement of the policy of the United 
States Navy Medical News Letter. In brief, this policy is to bring to the at- 
tention of its readers, timely up-to-date items of official and professional 
interest. Items of official interest include announcements of New Training 
Filnns, Training Programs, Newly Standardized Items, and special items such 
as the Dental Division's position on Hypnosis 39(3): 24-25, 40(1): 23-25, Oral 
Exfoliative Cytology 41(6): 22, 42(8): 22, and on Stannous Fluoride 42(7): 22- 
24. Publication of such items constitutes official announce nnent; it is each offi- 
cer's responsibility to note these announcements. 

A second aspect of official interest is the newsworthy item, such as 
professional meetings hosted by naval dental facilities, individual dental offi- 
cer's appearance on scientific or professional programs, and election to offi- 
cers or honors in scientific or professional organizations. The Editors of the 
News Letter are well aware of the fact that they may appear remiss in this 
category; however, with over 1700 dental officers in the field and fleet, it is 
impossible to publish such items unless the individual officers so honored 
submit the item of information to the Bureau of Medicine and Surgery. There- 
fore, each dental officer is urged to submit such items as rapidly as possible, 
for timely publication. 

Abstracts of articles in scientific literature and reports of successful 
practices at naval activities (Protective Mouthguard Program at the U. S. Navy 
Academy 40(2): 23) are the second category of interest published in the News 
Letter. The Editors attempt to publish those which will be most beneficial to 
the readers. On those occasions when an individual dental officer feels that a 
specific article is of such wide interest that it should be brought to the atten- 
tion of all naval dental officers, he should feel free to submit an abstract. While 
this practice has been current for some years, even more widespread partici- 
pation is encouraged. 

Naval Dental Corps Announces New Extension Course . The Naval Dental Corps 
announces availability of a new extension course, Advanced Speeds in Operative 
Dentistry (Nav Pers 10420). This course, the eleventh now offered in the ex- 
tension education program, was developed by the U. S. Naval Dental School, 
Bethesda, Md. 

The course of three assignments, covers the physical, biological, and 
clinical aspects of advanced speed instrumentation and includes H. R. Stanley's 
report, prepared for the Council on Dental Research of the American Dental 
Association, on the traunnatic capacity of high speed instrumentation. A text- 
book, assignment book, and slides are included in the course supplied by the 
Naval Dental School. 

The course, conducted by correspondence, is available without charge 
to all regular and reserve dental officers of the Armed Forces and to other 
members of the Federal Dental Services. Registration in the course or infor- 
mation about the program may be obtained from the Commanding Officer, 



26 Medical News Letter, Vol. 43, No. 2 

(Code E44), U.S. Naval Dental School, National Naval Medical Center, Bethesda, 
Maryland, 20014. 

Naval Examining Board To Meet Continuously . Effective February 1964, the 
Naval Examining Board will act continuously on applications for regular Navy 
as they are received in the Dental Division, Bureau of Medicine and Surgery, 
This is a change from previous practice wherein the Naval Examining Board 
previously met only semi-annually, in February and August. Candidates may 
expect to be notified of acceptance or rejection between four and six weeks 
after the application has been received by the Dental Division, Bureau of 
Medicine and Surgery. 

TV P romotes Children's Dental Health Week . A coast-to-coast television pro- 
gram starring Dick Van Dyke, February 5, will highlight the 1964 observance 
of National Children's Dental Health Week. The February 5 program in the 
regular weekly "Dick Van Dyke Show" has been purchased by Procter and 
Gamble and turned over to the American Dental Association as part of the 
Children's Dental Health Week observance. All commercial time will be used 
by the Association to present dental health messages. 

Local dental societies and individual dentists will be asked to participate 
in the advance promotion of the show so as to insure an even larger audience 
for the health messages. Advance publicity materials will include press re- 
leases, television spot announcements and school posters. 

Interest Increasing in Use of Stannous Fluoride . The New London Naval Medical 
Research Laboratory's clinical evaluation of SnF2 methods for caries pre- 
vention in naval personnel has recently been gaining increased interest among 
naval dental facilities. By invitation, CAPT F. P. Scola DC USN, principal 
investigator on this research subtask, lectured at the Naval Air Station, Quonset 
Point, Rhode Island, 21 November 1963 and at the Newport Naval Station, Rhode 
Island, on 22 November and the Naval Training Center at Bainbridge, Maryland 
on 5 Decennber 1963. 

N avy Graduates 66 Dental Technicians to the Fleet . The Naval Dental Technician 
School at the Naval Training Center, San Diego, California, held graduation 
ceremonies for the second group of Class "A" Dental Technicians (Basic) for 
fiscal year 1964, on 29 November 1963. The class of sixty-six well trained 
dental assistants, which included nine Waves, listened to an inspiring address 
by CAPT G. Courage DC USN, Chief of Dental Service, U. S. Naval Hospital, 
Camp Pendleton, Calif. 

Floyd S. Marsee of Orlando, Florida was honorman of the class in which 
twelve completed the course with a grade average of better than 90. C. T. Baker 
DTC USN served as class sponsor. CAPT W. A. Monroe Jr. DC USN is Director 
of Class "A" School Training. CAPT B. H. Faubion DC USN is Officer in Charge 
of the school. 

s!: :?£ * sjt Jj: * 



Medical News Letter, Vol. 43, No. Z 27 




PREVENTIVE MEDICINE 



Ready - Set - Snow 

Safety Review 20(12): 7 

Every winter, menibers of the National Safety Council's Committee on winter 
driving hazards study the effects of snow and ice to get the facts on winter driv- 
ing hazards and how to drive safely under the worst conditions. 

Industry, government, and educational institutions have contributed 
researchers, vehicles, and equipment. These experts kept going in the worst 
weather — so you can keep going when the going'a^bad. Here's how; 

First, get your car ready. 

1. Antifreeze. Flush cooling system, check for leaks and put in antifreeze. 

2. Tires. Install your winter tires before the first snowfall and make sure 
all tires have good treads. 

3. Chains. Always carry a pair of reinforced tire chains. In deep snow 
and ice, they help you stop and go more safely. 

4. Windshield Wipers. Be sure your wiper blades are in good condition 
and have arnn pressure of 1 ounce per inch of blade length to sweep 
snow and sleet off instead of sliding over it. 

5. Heater-Defroster. Make certain the heater-defroster is capable of 
keeping the windshield clear of ice and interior fogging. 

6. Lights. Be certain that both headlights work on upper and lower beanns 
and that stoplight, taillights, and directional signals work also. 

7. Brakes. Have them adjusted, relined if necessary; be sure brake linings 
are free of grease. 

8. Winter Tuneup. An engine tiineup is essential to fast cold-weather 
starting and helps avoid stalling. 

9- Muffler. A rusty, leaking muffler or exhaust pipe can be a carbon mon- 
oxide hazard, particularly if you are stalled in traffic, or a blizzard. 
10. Safety Belts. Install and use safety belts — a must in all types of weather 
but especially valuable under hazardous winter driving conditions. 

Then, get yourself ready. Know the six primary hazards of winter driving. The 
major hb.zards of winter driving are often referred to as inadequate traction 
and reduced visibility, but there are really six important points to consider: 

1. Effect of temperature on starting and stopping traction. 



28 Medical News Letter, Vol. 43, No. 2 

Z. Reduced visibility. 

3. Inadequate traction to go. 

4. Reduced ability to stop and steer. 

5. Unexpected icy conditions. 

6. Ice and snow made slippery by traffic. 

Remennber, stopping and steering are difficult on Ice and snow. Poor traction 
makes stopping difficult and stretches stopping distances to 250 feet or more 
from just 20 mph. That's almost 10 times the distance you need to stop on dry 
pavement. Steering is also extremely delicate on ice and snow. Forces that 
tend to throw your, vehicle into a skid are introduced as you steer into a turn. 
Any attempt to make a sudden steering change is extremely hazardous, 

^|C jfl 3^ 3^ Vfi ^fi 

Snow Tires Versus Chains 

The better snow tires give substantial advantage in loose snow and slush. But 
don't let this lead you to feel they afford similar advantage on ice or very hard 
packed snow, because snow tires are not much more effective than regular 
tires for these conditions. 

Regular chains will provide good stop-and-go traction on snow and ice, 
but their side -skid resistance on ice is poor compared to reinforced tire chains. 
Reinforced tire chains (each link of the cross -chain is reinforced by projecting 
teeth or cleats) are very effective on glare ice in reducing braking distances, 
opposing side skids and increasing forward traction as compared with regular 
chains. Particularly noticeable in these improved chains is their much better 
resistance to side skids. — Safety Section, Preventive Medicine Division, BuMed 

;;= :^ :}: sjc :^ Hs 

Courses Offered at the 
Disease Vector Control Center, Alameda, California 

1. Four week course in "Disease Vector and Pest Control Technology. " 

a. This course is open to all active duty officers and enlisted personnel of 
the Armed Forces and to civilian personnel of the Armed Forces engaged 
in vector and pest control activities. 

b. Attendance quotas for this course are allocated by communicating directly 

with the Officer in Charge, U. S. Navy Disease Vector Control Center, 
U.S. Naval Air Station, Alameda, California, 94501. 

c. Billeting and messing facilities are available at the Naval Air Station, 
Alameda, for both military and civilian personnel attending the course. 

d. Convening dates: 

1964 - 6 Jan-2 Mar-4 May-6 Jul-8 Sep-26 Oct 

1965 - 4 Jan-1 Mar-3 May-I2 Jul-13 Sep-25 Oct 



Medical News Letter, Vol. 43, No. 2 29 

2. Fourteen day active duty training course in "Biology and Control of Vector- 
Borne Diseases. " 

a. This course is open to Medical Department personnel and members of 
the Civil Engineering Corps, both officer and enlisted. Quotas can be 
obtained by making request to the appropriate Naval District Command. 

b. Quotas for the other military services are available by making request 
to the Bureau of Medicine and Surgery, Code 72, Department of the 
Navy, Washington, D. C. , 20390. 

c. Billeting and messing facilities are available at the Naval Air Station, 
Alameda. 

d. Convening dates: 

1964 - 2 Feb-5 Apr-7 Jun-9 Aug-11 Qct-8 Dec 

1965 - 7 Feb-11 Apr-6 Jun-8 Aug-10 Oct-5 Dec 

E merging Animal Diseases 

COL Fred D. Maurer VC USA, Dir of Path Div, USA Med Res Lab, Fort 
Knox, Ky. Military Medicine 128(4): 327-333, April 1963. 

The distribution, spread, and potential of blue tongue, African horse sickness, 
African swine fever, lumpy skin disease and Rift Valley fever are discussed 
as examples of emerging diseases. Such infectious animal diseases, having a 
strong influence on the world's food supply and its distribution, are of major 
economic importance to the United States, her allies, and the underdeveloped 

countries. 

The international control of such animal diseases would have far reaching 
benefits; it would increase the world's food supply, increase the efficiency of 
food production, free more people for other development, remove the threat 
of these diseases from coixntries now free of them, and greatly facilitate the 
distribution of food. Increased international trade in animal products would 
provide new purchasing power in underdeveloped areas, open new markets, and 
improve the economy of both agricultural and industrial countries. 

Blue Tongue. Blue tongue of sheep and cattle is an example of a rapidly 
spreading, insect transmitted, viral disease. Hyperemia and cyanosis of the 
tongue are responsible for the name. This febrile disease is characterized by 
inflammation of the mucous membranes of the upper respiratory and digestive 
tracts with erosions in the nasal and oral cavities. Edema of the head and neck, 
nasal discharge, respiratory distress, lameness due to coronitis, and loss of 
condition are commonly observed. The case fatality rate with some African 
strains of virus approaches 40%; the single strain in the United States is mild, 
producing relatively few fatalities. 

Blue tongue has been enzootic in South Africa since the first sheep were 
imported before 1800. Through the years it spread throughout most of Africa, 
but did not extend off the continent to Cyprus until 1924. Once in the Middle 



30 Medical News Letter, Vol. 43, No. 2 

East, through which there was more international traffic, blue tongue soon 
spread farther. About 1947, it appeared in Texas, but its identity was not con- 
firmed until 195Z, by which time it was discovered in several southwestern 
states. By I960, diagnosis of blue tongue had been confirmed in 13 states. Blue 
tongue was reported in Israel in 1951, in Portugal in 1956, soon thereafter in 
Spain and Morocco, and in Pakistan and Japan in 1959 and I960. 

Once established, the disease is difficult and costly to control. Nearly 
1 1/Z million doses of vaccine were made in the United States in 1959, and in 
South Africa commercial sheep raising is dependent upon the routine vaccina- 
tion of 35 million sheep. Immunization is further complicated in South Africa 
by the presence of 19 immunologically different strains of virus, against which 
they use a 12 strain polyvalent vaccine. The United States is still vulnerable 
to 18 of these strains. The rapid spread of blue tongue by the ubiquitous Culi- 
coides reveals their capability as vectors. 

African Horsesickness (AHS). African horsesickness, an insect-borne, 
febrile, viral disease of horses, mules, and donkeys, may be clinically domi- 
nated by an acute, rapidly fatal pulmonary edema or cardiac lesions with local- 
ized inflammatory edema of the head and neck. The cardiac changes include 
hemorrhage, edema, myocarditis, and focal necrosis. Hydropericardium, 
pleural effusion and gastritis are common. 

Known in Africa since 1700, AHS has been such a serious plague that 
horses never became the principal draft aninnal as in most western countries. 
During some years, nearly half the horse population died of this disease. 

Transmitted by Culicoides, the disease is seasonally associated with 
the presence of these insects, occurring after the rains in low, relatively nnoist 
areas. The disease has become enzootic in much of South and Equatorial Africa 
and made occasional seasonal forays into the northeastern areas of Africa. In 
the fall of 1959 it spread to Iran, Afghanistan, and West Pakistan. It persisted 
over the winter to reappear in those 3 countries in the spring of I960 and rapid- 
ly spread to India, Iraq, Syria, Turkey, Cyprus, Lebanon, and Jordan causing 
losses estimated at 300, 000 equine animals with case fatality rates of about 
80% in horses, and 60% in mules and with minor losses in burros. In the sum- 
mer of 1961, it reappeared in 5 of these countries. 

The recent outbreak of AHS in the Middle East would have been even 
nnore serious had it not been for the excellent work previously done in South 
Africa. There, during the last 30 years, they adapted the virus to mice, dis- 
tinguished some 42 immunologically different strains of virus and developed 
an effective polyvalent attenuated live virus vaccine. 

With some 12 million equine animals in the Middle East and no AHS 
vaccine being prepared there at the time of the 1959 outbreak, the need for 
vaccine was so great that the I960 outbreak was over before adequate amounts 
of vaccine could be produced or obtained by most countries involved with the 
exception of Iran and Turkey. Even though methods for control are known, it 
is obvious that international cooperation in their application is essential if the 
spread of such diseases is to be halted promptly and losses minimized, 

African Swine Fever (ASF ). African swine fever is an acute, febrile, 
highly contagious, virus disease of domestic swine, characterized by a short 



Medical News Letter, Vol. 43, No. 2 31 

course and essentially 100% mortality. Although producing clinical changes 
and lesions which closely resemble American hog cholera, it is caused by an 
immunologically different virus. Known in Africa since 1910, it has long pre- 
vented the comnnercial raising of swine in much of southern and Equatorial 
Africa. Carried by normal appearing African wart hogs and the rare domestic 
swine which survive, it persists in spite of the very high mortality. Trans- 
mission is primarily by direct contact; insects are not believed to play signif- 
icant roles in transmission. The virus is unusually hardy, having been reported 
to survive in uncooked Spanish sausage for 3 months. Numerous immunologically 
different strains of the virus have contributed to the lack of an effective vac- 
cine. 

In 1957, ASF spread to Portugal, resulting in the loss of over 48, 000 
swine from the disease and control slaughter up to December 1961. In the spring 
of I960, ASF appeared in Spain and quickly spread over most of the country 
resulting in losses from the disease and control slaughter of 165, 390 aninials 
up to December 1961. Pork products are important elements of the diet in these 
countries and the economic loss is of major significance. These outbreaks give 
evidence that ASF, in the absence of a vaccine, is the most potentially danger- 
ous of the swine diseases. Its presence on the Iberian peninsula greatly in- 
creases the threat to the rest of Europe and the western hemisphere. The clini- 
cal similarity to hog cholera increases the difficulty of its prompt recognition 
in a newly infected country. As evidenced by the rapid spread of vesicular exan- 
thema of swine throughout the United States in 1952, the way in which American 
swine are moved en masse from breeder to feeder, and to market, provides 
ample opportunity for the rapid dissemination of a disease life ASF. Essential 
to control is an alert veterinary service trained in the recognition and prompt 
confirmatory diagnosis of the disease. The need for an effective vaccine is 
paramount. 

Lrumpy Skin Disease. This febrile, insect-borne, virus disease of cattle 
provides an excellent example of a new, local disease problem which grew to 
handicap the cattle industry of a whole continent through lack of international 
disease control. First recognized in Northern Rhodesia in 1929, the opportu- 
nity to eradicate it was missed during the next 15 years before it spread to 
nearby Southern Rhodesia, Bechuanaland, and the Union of South Africa, There, 
apparently disseminated by more capable or more numerous insect vectors, it 
spread rapidly throughout those countries and on to Swaziland, and Mozambique. 
During this period of rapid transmission an estimated 8 million animals were 
affected and in some districts the case fatality rate reached 75%. In areas where 
the disease has become enzootic the case death rate is usually less than 5% but 
the loss of weight, reduced milk production, and damage to hides make affected 
animals unprofitable. 

Hide damage results from raised cutaneous nodules which characteristi- 
cally develop in large numbers during the acute disease. Similar nodules, some 
of which become necrotic, may also occur in portions of the respiratory and 
digestive tracts. Numerous epithelial cells in these nodules are swollen, fre- 
quently vacuolated, and reveal cytoplasmic inclusions. The nodular lesions are 



32 Medical News Letter, Vol. 43, No. Z 

accompanied by a generalized lymphadenitis with gross enlargement of the 
lymph nodes. 

Two strains of virus, the Allerton and Neethling strains, have been 
shown to produce lumpy skin disease. The Neethling strain is more pathogenic 
and the one of major significance. It has now been grown on bovine tissue cul- 
ture wherein serial passage led to attenuation and the production of an efficient 
vaccine. This virus is inrjmunologically so closely related to sheep pox that in 
Kenya the sheep pox virus has been used to innmvinize cattle against it. 

Now having spread over much of South and Central Africa and off the 
continent to Madagascar by insect vectors, this formidable disease appears to 
have such a potential for spreading that only international cooperation will lead 
to its control. 

Rift Valley Fever (R. V. F. ) The current large scale importation of pri- 
mates from Africa poses a new hazard for the introduction of R. V. F. into the 
United States, This highly infectious, insect-borne, febrile, viral disease of 
sheep, cattle, and man has spread throughout much of Africa and is a serious 
hazard to other continents. When it spread from Equatorial Africa to the Union 
of South Africa in 1951, it destroyed over 100, 000 sheep with a case fatality- 
rate in lambs of 90%. Losses of cattle ranged up to 25% of the cases and there 
were an estimated 22, 000 human cases. ForttAate-ly, the virus usually pro- 
duces only a relatively mild influenza -like disease in man except for occasional 
sequelae of iridocyclitis. 

At least 7 species of African monkeys have been found to carry anti- 
bodies against R. V. F. Experimentally, it usually produces anon-clinical virus 
in primates which lasts for several days. Since most primates are shipped to 
the United States via air, there is ample time for a R,V.F. infected animal 
to arrive here with a viremia. 

With the United States having Culex and Aedes mosquitoes which are 
potential vectors, the stage appears to be set for the entry and dissenoination 
of R.V. F. Other countries with potential vectors face the same hazards when 
primates are imported without an adequate period of insect-free quarantine 
and surveillance. 

>[! sj: * * >;« * 

Salmonella derby Gastroenteritis 

DREW PHS, Public Health Reports 78(10): 855, October 1963. 

In March 1963, clusters of laboratory isolations of Salmonella derby reported 
by State health departments alerted the Public Health Service's Commimicable 
Disease Center in Atlanta to an outbreak of S. derby gastroenteritis. The re- 
ports showed a clustering of such isolates in the New York City area. Five cases 
of diarrhea in one hospital prompted an investigation by the New York City Health 
Department with CDC assistance. 

Similar clusters of S. derby isolations subsequently appearing in New 
York State, Pennsylvania, New Jersey, and Massachusetts mainly represented 



Medical News Letter, Vol. 43, No. 2 33 

cases of S. derby gastroenteritis acquired in hospitals. Of 775 S. derby iso- 
lations reported to CDC from March 1 to July 8, 1963, from 25 States and the 
District of Columbia, 601 represented hospital-associated cases. 

By early April 1963, hospitals, city and State health departments, the 
CDC, and the Food and Drug Administration had joined the search for a source 
common to the hospitals with patients harboring S. derby. Analysis of case 
records and interviews at these hospitals ruled out human carriers among phy- 
sicians, nurses, and other hospital personnel; medications were also eliminated 
as a source, A careful study of all foods revealed that raw or undercooked eggs 
had been consumed by more patients than any other single food item or medi- 
cation within the 48 hours before onset of illness. Patients who developed S. 
derby gastroenteritis were also apparently more likely to consume raw or under- 
cooked eggs than the total hospital population at risk. 

With this lead, possible egg sources of 13 of the affected hospitals in 
three States were investigated. The number of S. derby organisms recovered 
from cracked eggs from farnns in one of the geographic areas supplying these 
hospitals led the Public Health Service to issue this recommendation: 

There is sufficient epidemiologic and bacteriological evidence to suggest 
that everyone should avoid buying and using cracked or unclean eggs. Persons 
who are ill, especially infants, the elderly, and persons suffering from gastro- 
intestinal disease or malignancies, should not be fed raw or undercooked eggs. 
An undercooked egg is one in which the white is not firnn. 

j«! 4: sis :^ sj! :{! 

Epizootics of Sylvatic Plague in Colorado 

Vector Control Briefs DHEW PHS CDC, Atlanta, Ga. (10): 2, November 
1963. 

Widespread epizootics of plague occurred in Colorado during the spring and 
summer of 1963. In the early spring, plague was detected in a large colony of 
prairie dogs in Park County, southwest of Denver. An epizootic soon developed, 
and by early June the prairie dog colony was completely wiped out. Plague was 
subsequently detected in a dead prairie dog picked up on the Lowry Air Force 
Missile Site just east of Denver, and another epizootic developed in this area. 
The Colorado State Department of Public Health inaugurated a program of sur- 
veillance and vector and rodent control to prevent the introduction of plague into 
the domestic rat population of the Denver municipal area. To date, there have 
been no isolations of plague bacilli from fleas or rodents collected in this area. 
The Greeley and San Francisco field stations of the Disease Ecology Section, 
Technology Branch, CDC, are collaborating with the State Department of Public 
Health and the U.S. Air Force in studying the epizootic. The State Aids Section 
has provided assistance in the development of vector and rodent control meas- 
ures. 

;}: :^ :!: ^ :jc ^ 



34 Medical News Letter, Vol, 43, No, 2 



Ittofo WIr Mnrlrf 




Did You Know: 

That an electric shock is used to safely extract scorpion venom? Scorpi- 
ons are placed in a large jar, introducing CO_ into the jar to anesthetize, this 
is usually effective within 3 to 5 minutes, Eacli scorpion is placed in a specially 
modified mousetrap, with only the telson and 1 or Z terminal segments pro- 
truding beyond the crossbar of the trap; 2 electrodes are applied to the post- 
abdomen. By this stimulation the venom is usually emitted immediately onto a 
glass microscope slide. The scorpion is released from the trap and transferred 
to a holding jar to await return to the original colony. It has been possible to 
collect venom from as many as 400 scorpions on a single slide. The pooled 
venom can then be dried and preserved. 

This method has made it possible to nnaintain a laboratory colony of over 
5, 000 live adult scorpions and to study the secretion and composition of the ven- 
onn. As much as 66. 4% of the venom content of the telson could be obtained by 
electrical stimulation. (1) 



That a Symposium on Venereal Disease Control, which was convened by 
the WHO Regional Office for Europe, and held in Stockholm, Sweden, from 24 
to 28 September 1963, was attended by senior health administrators and by epi- 
demiologists responsible for national venereal disease control programs from 
18 European countries? 

The Symposium's main purposes were to bring before health authorities 
present and long-term trends in gonococcal and syphilitic infections in European 
coimtries, in view of the rising incidence of these diseases in recent years as 
reported from many parts of the world, and to study and discuss the niethods 
presently in use in these countries for the control of venereal disease with a 
view to possible improvennents. Among epidemiological aspects of the problem, 
the Symposium considered ways of promoting inter-country cooperation in com- 
bating venereal disease, and explored the possibility of strengthening existing 
public health measures by intensifying their social and educational aspects and 
improving legislation relating to venereal disease control, (2) 



That human consumption of overwintered cereals (millet, wheat, barley) 
causes a disease known as septic angina? The factors conducive to the formation 
of toxins in cereals that have passed the winter under snow cover were studied 



Medical News Letter, Vol. 43, No. 2 35 

from 1943 to 1950 in the Orenburg district of the Russian Confederate Republic 
of the USSR. The toxic principles persisted in stored millet grain after 6 year's 
storage. Only grain in contact with soil during the winter-spring period devel- 
oped toxicity. Soil fungi were found to be able to produce various degrees of 
toxicity, species of Fusarium being most highly toxic. The toxic principle oc- 
curred about as frequently in the soil as in the cereal grains, but vegetative 
parts of the plants were less frequently toxic. (3) 



That in 1921, the Rocky Mountain Laboratory of the PHS was founded 
in Hamilton, Montana, to study Rocky Mountain spotted fever? Since that time, 
this Laboratory has evolved from a few cabins into a modern $3 million re- 
search complex? 

During the early days, a Rocky Mountain spotted fever vaccine was de- 
veloped for immunizing man; manufacture of this was cumbersome, expensive 
and dangerous. Later, a chicken-embryo type of vaccine was developed which 
is now the standard method of immunization. 

This laboratory conducts extensive research on Q fever and other rick- 
ettsial infections, zoonoses of regional importance, transmission of disease 
agents by certain vectors, the mechanisms of allergy and their roles in disease, 
microbial proteins and nucleic acids, production of vaccines for the prevention 
of tuberculosis, the structure and biologic activity of endotoxins, the role of 
morphological elements of microorganisms in immunity and related phenomena, 
the encephalitides, Colorado tick fever, and the relation of viruses to chronic 
disease, (4) 



That inadequate nutrition and poor sanitation are the cause of intestinal 
diseases that decimate 2/3 of the world's population, and that in large areas, 
1 to 5 infants out of 10 fail to reach the age of 1 year? 

With a view to improving the situation, the World Health Organization 
convened an expert committee on the control of enteric diseases, which fin- 
ished its work in Geneva on 18 November 1963. (5) 



That on 8 October 1963, the Surgeon General of the Public Health Service 
approved the establishment of the Aedes aegypti Eradication Branch within the 
Communicable Disease Center, Atlanta, Ga. Dr. Donald Schliessman, formerly 
with the Epidemiology Branch, and more recently with the Technology Branch, 
will be chief of the new branch. (6) 



Bibliography: 

1. WHO Chronicle, Notes & News, A Safe Method of Extracting Scorpion Venom 
17(10): 383-384, October 1963. 



36 Medical News Letter, Vol. 43, No. Z 

2. WHO Chronicle, European Symposium on VD Control 17(10): 386, October 

1963. 

3. Public Health Engineer Abstracts, Abst. No. 1213, XLin (7): 215, July 1963. 

4. Veterinary Public Health Notes USDHEW PHS CDC Atlanta, Ga. October 

1963. 

5. WHO Press Release, SEAR 738, Regional Office for Southeast Asia, 19 

November 1963. 

6. Veterinary Public Health Notes USDHEW PHS CDC Atlanta, Ga. , Aedes 
aegypti Eradication Branch Established at CDC, pg 14, October 1963. 

3i! * :{! :^ * * 

C hloramphenicol Resistance of Salmonella 

WHO Chronicle 17(5): 185, May 1963. 

In pursuance of a proposal made by the WHO Expert Committee on Antibiotics 
(1), the National Salmonella and Escherichia Center in Kasauli, Punjab, has 
tested the sensitivity to chloramphenicol of 867 Salmonella strains isolated 
from patients and from animals in various parts of India over the period 1959- 
1961 (2). These strains belonged to 24 serotypes, but almost 80% were Salm. 
typhi while another 7% were Salm . paratyphi A. As recommended by the Expert 
Committee, the determination of sensitivity was made by the dilution method. 
The concentrations used were 1, 2,4, 6, 8, 12 and 16 mg of chloramphenicol per 
ml of nutrient agar, sensitivity plates being prepared by pouring 25 ml of 
chloramphenicol-agar mixture into Petri dishes. Each dish was divided into 4 
quadrants and each quadrant inoculated with a distinct strain that had been grown 
for 18 hours at 37° C on nutrient broth. The culture plates were then incubated 
at 37° C 24 hours. As a control, a parallel series of tests was carried out on 
each strain without chloramphenicol. 

About 40% of the Salm. typhi strains were resistant to a chloramphenicol 
concentration of 2 mg/ml of medium but susceptible to 4 mg. A further 20% 
were resistant to concentrations below 6 mg/ml and about 9% to concentrations 
below 16 mg. There was a gradual increase in resistance from 1959 to 1961. Of 
the Salm. paratyphi A strains, approximately 50% were susceptible to concen- 
trations of 4 mg/ml or more and another 30% were killed when the concentration 
was increased to 6 mg/ml. The remaining serotypes showed a similar pattern 
of resistance, the majority of the strains in each case being susceptible to 4-8 
mg of chloramphenicol per ml of medium. 

References 



1. World Health Organization Techn Rep Ser 1961, pg. 210. 

2. Agarwal, S. C. (1962) Bull World Health Organization 27: 331. 

(HlthPrac Br, Prev Med Div, BuMed) 



* };c sj: >J: * * 



Medical News Letter, Vol. 43, No. 2 37 



Evaluation of Malathion Dust 
for the Control of Body Lice 

William W. Barnes*, B. F. Eldrige, J. H. Greenberg, and S. Vivona. J 
Econ Entom 55(5): 591-594, October 1962. Summary from Pub HIth Eng 
Abstr 453-691, XLm(4): 92, April 1963. 

From January 9 through March 6, 1961, a field evaluation was conducted at a 
Republic of Korea Army prison farm near Seoul, Korea, to determine the effi- 
cacy and safety of 1% malathion dust used to control body lice ( Pediculus hu - 
manus huraanus L. ). One ounce of dust applied either semimonthly by hand or 
monthly by power duster gave virtually 100% control. Monthly applications of 
the same dosage of 1% lindane powder gave poor contrpl. Lice from the test 
subjects were resistant to DDT but susceptible to lindane and malathion as 
determined by laboratory tests. Physical examination and weekly red blood cell 
cholinesterase determinations revealed no adverse effects from malathion dust 
used on 200 test subjects. 

* Army Environmental Hygiene Agency, Army Chenaical Center, Md. 

>ic jjc :{: 4: ^ ^ . . 

Tularemia, Spotted Fever, and Murine Typhus 

1958-1962 

Vector Control Briefs, DHEW PHS CDC, Atlanta, Ga. Vectors and Vector- 
Borne Diseases (10): 4, November 1963. 

The "Annua l Supplement — Reported Incidence of Notifiable Diseases in the United 
States, " 1962 — Morbidity and Mortality Weekly Report 11(53), released 16 Sep- 
tember 1962, contains interesting information on the incidence of tularemia, 
spotted fever, and murine typhus as follows: 

Disease Number of Reported Cases 



958 


1959 


I960 


1961 


1962 


587 


459 


390 


365 


328 


71 


51 


68 


46 


32 


243 


199 


204 


219 


240 



Tularemia 

Typhus fever, flea-borne (murine) 

Typhus fever, tick-borne (Rocky Mt. spotted) 

The number of cases of tularemia has shown a continued decrease since 1948, 
Cases of tularemia occur most frequently in Southeastern United States, with 
Arkansas often the leading State. The Morbidity and Mortality Weekly Report 
for July 5, 1963, 12(26): 214-215, contains the following significant paragraph 
based on cases reported during I960 and 1961: 



38 Medical News Letter, Vol. 43, No. 2 

"The seasonal distribution of tularemia cases shows 2 distinct peak 
periods of activity. The increased incidence during summer months is due 
primarily to cases acquired from infected ticks and flies, while the late fall 
and winter peak which occurs each year represents those cases caused by ex- 
posure to infected wildlife. " 

The 32 cases of murine typhus represents the smallest number reported 
to the Public Health Service since 1920, Texas continued to report the largest 
number, 12, followed by Georgia, with 5 cases. 

Rocky Mountain spotted fever continues to be reported more often from 
the Atlantic Coast and Southeastern States than the Rocky Mountain area. In 
1962, 7 cases were reported from Montana as compared with 45 in Virginia, 
35 from North Carolina, 21 from Tennessee, 16 from Maryland, and 11 each 
from New York, Alabama, and Oklahoma, 

^ ^ ^ :}: ^ ^ 

Isolation of Rickettsia rickettsii from 
Wild Mammals in Western Montana 

W, Burgdorfer, V. F. Newhouse, E.G. Pickens, and D. B. Lackman, Ecolo- 
gy of Rocky Mountain Spotted Fever in Western Montana. Amer J Hyg76(3): 
293-301, Novernber 1962, Summary from Pub Hlth Eng Abstr XIJ:iI(4): 87, 
April 1963. 

In studies of the ecology of Rocky Mountain spotted fever rickettsiae conducted 
on the west side of the Bitter Root Valley in western Montana, golden-mantled 
ground squirrels (Citellus lateralis tescorum), chipmunks ( Eutamias amoenus ), 
Columbian ground squirrels (Citellus columbianus columbianus), woodrats 
(Neotoma cinerea cinerea), and snowshoe hares ( Lepus americanus ) were ex- 
amined serologically for complement-fixing antibodies to Rickettsia rickettsii . 
Attempts were also made to isolate strains of this agent from blood and spleen 
tissues. 

Complement-fixing antibodies were detected in 23 of 33 golden-mantled 
ground squirrels, 5 of 7 chipmunks, 6 of 13 Columbian ground squirrels, and 
in 24 of 55 snowshoe hares. No evidence of previous spotted fever infection was 
noted in sera of 17 woodrats. 

Seven strains of rickettsiae were recovered and were identified as highly 
virulent R. rickettsii based on their behavior in guinea pigs, embryonated hens' 
eggs, and~in complement-fixation tests. One strain was isolated from the blood 
of a young snowshoe hare, 1 strain from the spleen of a young golden-mantled 
ground squirrel, and 5 strains from spleen tissues of young chipmunks. These 
strains of spotted fever rickettsiae are the first isolations made from naturally 
infected wild mamnnals west of the Mississippi. 

9}: :{c 9}: ^ i^c :{: 



Medical News Letter, Vol. 43, No. 2 39 




RESERVE "^^F^ SECTiOIV 



Research Reserve Seminar* 



The Research Reserve is pleased to annoiince the scheduling of an additional 
Research Reserve Seminar for this fiscal year — Nuclear Sciences Seminar in 
Health Physics, Brookhaven National Laboratory, Upton, New York, convening 
2 March 1964. Quotas for this seminar have been allocated to the following 
Naval Districts: 1,3,4,5,6,8, and9. Quotas may be given to the West Coast 
Naval Districts upon request of the respective Commandants. Reservists who 
request this duty should have at least a Bachelor's degree in one of the sciences 
or engineering. 

The profession of the Health Physicist developed out of necessity with 
the coming of the nuclear age. The term Health Physics is sometimes equated 
with Radiation Safety, but this is an inadequate definition. The Health Physicist 
thinks of his profession as being concerned with the study, evaluation and con- 
trol of radiation hazards. The modern nuclear-age Navy needs reservists who 
have been indoctrinated in the basic tenets of the Health Physics profession. 
The program of the 10th Brookhaven Seminar has been laid out with this in mind. 

The program will cover the Health Physics profession with special at- 
tention to the needs of the Navy and its reservists. These will include Inter- 
actions of Radiation and Matter, Biological Effects of Radiation, Personnel 
Monitoring and Radiation Surveys, together with practical applications of prob- 
lems in reactors, laboratories and hospitals. The facilities and personnel of 
Brookhaven National Laboratory will be augmented, so that adequate coverage 
will be given to these problems as associated with shipyards, naval vessels, 
and nuclear energy and man in space. Tours of Brookhaven's nuclear facilities 
will be included. 

* Submitted to the Medical News Letter by Research Reserve, Office of Naval 
Research, Washington, D. C. 

:(:>}: >|c »|c :^ ^ 



Reserve Medical Officers 
Certified by American Boards 

American Board of Psychiatry & Neurology in Neurology 

LCDR Franklyn C. Hill Jr. MC USNR 
LT Donald M. Levy MC USNR 



40 



Medical News Letter, Vol. 43, No. 2 



American Board of Psychiatry & Neurology in Psychiatry 

LT Ronald M. Backus MC USNR 
L.CDR James H. Duffy MC USNR 
L,T Alfred E. Fireman MC USNR 
LGDR Donald G. Glasco MC USNR 
LCDR Milton Si rota MC USNR 
L,CDR Edward C. Smith MC USNR 
LCDR Wiley R. Smith Jr. MC USNR 
LCDR James S. Ward MC USNR 
LT William E. Waterman MC USNR 

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